A bill awaiting the signature of Gov. Jared Polis, which will fund training for Colorado health workers to help them work better with different populations, is a good start, but it won’t affect all the ways the system prevents some people, advocates say.

HB22-1267, which cleared the legislature on the penultimate day of the session, will create a $ 900,000 grant program to hire contractors to train health professionals on how to provide culturally appropriate assistance to “priority populations”. Whether he will sign the bill, Polis did not say.

The definition of priority population groups is broad, including people of color; veterans; LGBTQ; people who are homeless or in the criminal justice system; people with HIV or AIDS; older people; “Children and families”; and people with disabilities.

While boards that oversee medical licensing will be ordered to encourage providers to complete training, for providers who do not, there is no penalty.

Interest in how to better care for different patients seems to be growing, especially since the pandemic highlighted existing health differences, said Robert King, vice president of diversity, equity and inclusion at Colorado Access, which manages care for some Colorado members Medicaid and acquired some lessons from third-party vendors to offer vendors.

Training can cover issues such as prejudice, privileges, and how systems have failed or actively harmed colored people in the past to affect whether they trust healthcare professionals today.

“The training itself will not lead to sustainable results, but it is a necessary ingredient,” King said.

In September 2020, conducted by the Pew Research Center, about 76% of black respondents believed that they were less likely to be treated fairly in health care facilities than white people. Most white respondents do not believe that black people are more likely to face unfair treatment. The survey did not ask whether other groups were treated unfairly.

Interactions between providers and patients can be daunting, especially if there is a difference in culture or social class, said Robert Friedland, director of the Center for the Aging Society at Georgetown University. Knowing that patients from other communities may have different ideas than their doctors, such as whether a person with a dead brain should be considered dead if his heart hasn’t stopped beating, can help set up better conversations, he said.

“I think a lot of it is focused on communication and mutual understanding,” he said. Cultural response is a “toolkit and sensitivity”.

Typically, medical students undergo several days of training in communicating with different groups of patients, and they can occasionally take additional education courses on the subject as providers, Friedland said. The training is usually aimed at people of different nationalities and religions, although classes are sometimes held on LGBTQ people and people with various disabilities, he said.

If patients trust their doctors, they are more likely to follow medical advice, whether it be vaccinations or taking measures to manage chronic diseases, King said. And they are more likely to trust suppliers who understand where they come from and try to meet their needs, he said.

“If you look at vaccine implementation rates (COVID) … the key factor is trust,” Friedland said.

However, better patient relationships are only one part of the solution, King said. Patients will not receive better care if the office is only open when they are at work, not accessible to people with disabilities and not offering assistance in navigating complex systems surrounding care for the elderly, he said.

“Training is about 20% of the equation,” he said. “If the system doesn’t change, if the structure doesn’t change, any effect will be negligible.”

Cultural gaps in vaccine distribution

Maria Gonzalez, CEO of Commerce City Adalante Community Development, said that during the pandemic, the need for cultural competence became apparent.

Initial efforts by state and local health departments to vaccinate against COVID-19 have not focused on the needs of the Latin American community, and an identification request on some sites has raised suspicions among people who did not trust the government with health information or worried about their immigration status, she said. .

Some sites did not have bilingual staff who could answer people’s questions, and it was even difficult to find Spanish versions of the forms filled out by vaccine recipients, Gonzalez said.

In the first months of the vaccine’s introduction, the recipients were disproportionately non-Hispanic white Colorado, although the difference has narrowed somewhat since then as the staff has hosted clinics in underserved areas. Colored people are disproportionately likely to get COVID-19 and die from it across the country, although it is difficult to know to what extent Colorado had the same pattern because in many cases there was no evidence of race or ethnicity.

“There were so many barriers,” she said.

Practical considerations, such as how accessible the medical site is, whether there are convenient hours and offers interpreter services at each stage of the interaction, can be just as important for cultural competence as having well-trained staff, according to Georgetown University Institute of Health Policy. It is also possible to work with people who know the community well, be it staff who share the patient experience, community health professionals or traditional healers (if possible without compromising care).

Adalante is not usually concerned with health issues, focusing on economic development and assisting Latin American business owners. But employees are part of the community and knew how to talk to people about their problems, Gonzalez said, estimating that they contributed about 15,000 shots thanks to a partnership with Colorado Access that provided staff and funding.

They also knew that setting up at the Mile High weekly flea market and in apartment and mobile home complexes would attract people who were not against vaccination but were unable to make vaccination easy, she said.

“We didn’t have to ask,” she said.

Patients who feel supported seek more help

While race and language most often arise when discussing cultural competence, some of the biggest supporters of the Education Funding Bill are organizations representing the LGBTQ community.

In a 2018 poll commissioned by One Colorado, about one-third of people who identify as LGBTQ said they do not have proper access to health care providers who understood their needs, and 36% said they did not reveal their gender identity or sexual orientation because they were concerned about discrimination in the provider’s office.

Dr Jude Harrison, a recently retired family doctor in Durango who identifies himself as a transsexual, said that even having options other than “male” and “female” to indicate patients on admission forms could be helpful.

So you can get rid of gender language when there is no need to, for example, ask about the patient’s parents rather than about the mother and father when collecting a health history. With some exceptions, the gender of a relative does not matter when determining whether a patient has a family history of risk of disease, he said.

“A lot comes down to the fact that someone is not heterosexual and cisgender,” he said. “If people are treated with respect, it greatly increases the chances that someone will seek help and they will seek it immediately.”

Harrison said transgender people find it especially difficult to get medical care, even if the reason they seek help is not related to their gender identity. It doesn’t matter if a patient is transsexual if he has a sore throat or a broken wrist, but a significant percentage of doctors still say they can’t treat those patients, he said.

A One Colorado survey found that if respondents felt that their health workers understood and supported LGBTQ people, they were more likely to visit doctors last year and receive routine care such as flu shots and cancer screening. About 78% of people who said their provider understood their needs had attended primary care the previous year, compared to 52% of those who did not feel comfortable with their provider.

“You don’t have to understand someone’s sexual orientation either gender identity treat them with compassion and respect, ”Harrison said.

Doctors are worried because Colorado is collecting data on the diversity of suppliers

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Citation: Colorado is starting to fund culture-based health education. What does that mean? (May 24, 2022) Retrieved May 24, 2022, from https://medicalxpress.com/news/2022-05-colorado-fund-culturally-responsive-health.html

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